MULTIDRUG-RESISTANT TUBERCULOSIS: What Nurses Should Know. Felissa R. Lashley, RN, PhD, FAAN, FACMG Professor , College of Nursing, and Interim Director, Nursing Center for Bioterrorism and Infectious Disease Preparedness, College of Nursing Rutgers, The State University of New Jersey

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MULTIDRUG-RESISTANT TUBERCULOSIS: What Nurses Should Know

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Interim Director, Nursing Center for Bioterrorism and Infectious Disease Preparedness, College of Nursing

Rutgers, The State University of New Jersey

This module is designed to highlight important information about multidrug resistant tuberculosis (MDR-TB). MDR-TB is also considered to be a potential agent for bioterrorism and is considered as a possible Category C bioterrorism agent by the Centers for Disease Control and Prevention (CDC). This module was supported in part by USDHHS, HRSA Grant No. T01HP01407.

MDR-TB is considered as a Category-C biological agent in regard to its potential for use in bioterrorism by the CDC.

These agents are considered as possible emerging public health threats and are considered as such in the module on Biological Weapons: Essential Information on Category C Agents.

XDR-TB (extensively resistant tuberculosis) refers to cases of TB that are resistant to isonazid , rifampin, the second line drugs, the fluoroquinolones, and at least one of three injectable drugs. i.e. amikacin.

MDR-TB is defined as a case of TB caused by a strain of M.tuberculosis that is resistant to two or more antituberculosis drugs. Some define MDR-TB as a case of TB caused by a strain of M.tuberculosis that is resistant to isoniazid and rifampin.

Latent TB infection in which persons are infected with tubercle bacilli but are not infectious to others nor show clinical symptoms but do usually have a positive reaction to the tuberculin skin test but usually negative chest radiograph. They may be candidates for preventive drug therapy,

OR

Active TB in which they are infected with tubercle bacilli, usually have positive sputum smears and cultures, usually have a positive reaction to the tuberculin skin test, usually have clinical symptoms, and may be infectious to others before treatment is effective.

Tuberculin skin test with purified protein derivative as screen; anergy may be seen in elderly and the immunosuppressed.

Chest x-ray or radiograph of extrapulmonary site shows characteristic findings of abnormalities in apical or posterior segments of upper lobe or superior segments of lower lobe but is not used to confirm diagnosis of pulmonary TB.

Initial non-MDR-TB therapy in drug-susceptible disease calls for 8 weeks of therapy with isoniazid, rifampin, pyrazinamide, and ethambutol followed by a continuation regimen of isoniazid and rifampin for 18 more weeks as the most frequent option.